Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

Integrating Existentialism and Super's Life‐Span,Life‐Space Approach

As workers face a changing and ever‐complex employment landscape, traditional career theories and approaches may not be sufficient in meeting career challenges. Calls for integrated career theories have emerged as more people seek meaning and purpose in their lives and careers. This article proposes a career counseling option that integrates existentialism and Super's (1990) life‐span, life‐space approach to establish a foundation for a broader approach to career development that views clients holistically by exploring life and career meaning and purpose from a developmental perspective. A case example and interventions are provided to demonstrate practical application and a contextual framework, along with implications for counselors.     

Leadership of highly creative people in highly creative fields: A historiometric study of scientific leaders

In recent years there has been a marked increase in the study of the influence of leadership on creativity, and the effects of this relationship on organizational performance. While a number of explanations have been broached with regard to the positive effects of leadership on creativity, many of these studies propose different, and often contradictory, methods for leaders to achieve these positive effects on creativity within their organizations and work groups. Additionally, little work has been done examining the effects of leadership on highly creative people in fields requiring creativity. The purpose of this study is to examine two existing leadership theories with regard to their viability as models to explain creative performance of eminent scientists. Eminent scientists represent a population of leaders of highly creative individuals in a field that values the production of innovative ideas and products as a marker of performance. Ninety-three excerpts from the biographies of scientists were content coded for leader behaviors and performance criteria. The results of this analysis indicate that a model based on strategic planning and product championing may serve to explain the positive effects of leadership on creativity in a highly creative population.     

Machine Learning for Drug Overdose Surveillance

ABSTRACT

We describe two recently proposed machine learning approaches for discovering emerging trends in fatal accidental drug overdoses. The Gaussian Process Subset Scan (Herlands, McFowland, Wilson, & Neill, 2017 Neill, D. B. (2017). Multidimensional tensor scan for drug overdose surveillance. Journal of Public Health Informatics, 9(1), e20. doi:10.5210/ojphi.v9i1.7598[Crossref] , [Google Scholar]) enables early detection of emerging patterns in spatio-temporal data, accounting for both the complex, correlated nature of the data and the fact that detecting subtle patterns requires integration of information across multiple spatial areas and multiple time steps. We apply this approach to 17 years of county-aggregated data for monthly opioid overdose deaths in the New York City metropolitan area, showing clear advantages in the utility of discovered patterns as compared to typical anomaly detection approaches. To detect and characterize emerging overdose patterns that differentially affect a subpopulation of the data, including geographic, demographic, and behavioral patterns (e.g., which combinations of drugs are involved), we apply the Multidimensional Tensor Scan (Neill, 2017 Neill, D. B. (2017). Multidimensional tensor scan for drug overdose surveillance. Journal of Public Health Informatics, 9(1), e20. doi:10.5210/ojphi.v9i1.7598[Crossref] , [Google Scholar]) to 8 years of case-level overdose data from Allegheny County, Pennsylvania. We discover previously unidentified overdose patterns which reveal unusual demographic clusters, show impacts of drug legislation, and demonstrate potential for early detection and targeted intervention. These approaches to early detection of overdose patterns can inform prevention and response efforts, as well as understanding the effects of policy changes.     

Sexual Victimization and Sex-Related Drinking Motives: How Protective is Emotion Regulation?

One in five college women experience sexual victimization (SV), and SV severity is associated with subsequent psychological distress, including sex-related distress. SV severity may also be associated with drinking motives to cope with sex-related distress and to enhance sex (sex-related drinking motives [SRDMs]), particularly if individuals suffer from emotion regulation (ER) difficulties. College women (N = 151) completed a survey assessment of ER, SV history, childhood sexual abuse (CSA), and SRDMs. Twelve regression models assessed six facets of ER as moderators between SV severity and SRDMs. Among women with no or low levels of prior SV severity, women with greater access to ER strategies were less likely to endorse drinking to cope SRDMs. At higher levels of SV severity, women at all levels of access to ER strategies were equally likely to endorse drinking to cope SRDMs, suggesting that access to ER strategies did not mitigate motivations to drink to cope with sex-related distress for these women. Women with severe SV histories may benefit from interventions that build on existing ER strengths or address other factors. However, greater access to ER strategies may serve as a protective factor against SRDMs when SV severity is low.     

Association between sexually explicit messages and sleep health among French sexual minority men

It has been demonstrated that sexual minority men (SMM) participate in sexting. While research has shown that engagement in the exchange of sexually explicit media is associated with poor health outcomes, no previous research has investigated its association with sleep health outcomes. This study sought to examine the association between sexually explicit media and sleep health among SMM, a population that suffers from poor sleep health. A popular geosocial networking application was used to recruit SMM individuals (N?=?580) in the Paris, France, metropolitan area. Multivariate analyses, adjusting for sociodemographics, were used to test the association between the frequency of sexually explicit messaging and three dimensions of sleep health: (1) sleep quality, (2) sleep duration, and (3) two aspects of sleep problems. In multivariate analyses, those who reported engaging in sexually explicit messaging more were more likely to report getting less than seven?hours of sleep (aRR = 1.24; 95% CI = 1.08, 1.43) compared with those who reported engaging in sexually explicit messaging less. No significant associations were found between sexting and sleep quality or reporting sleep problems. Sexually explicit messaging was associated with shorter sleep duration. Intervention targeted at individuals who sext could potentially improve sleep health outcomes.     

Comparing the U.S. Decennial Census Coverage Estimates for Children from Demographic Analysis and Coverage Measurement Surveys

Following every U.S. decennial census since 1960, the U.S. Census Bureau has evaluated the completeness of coverage using two different methods. Demographic analysis (DA) compares the census counts to a set of independent population estimates to infer coverage differences by age, sex, and race. The survey-based approach (also called dual system estimation or DSE) provides coverage estimates based on matching data from a post-enumeration survey to census records. This paper reviews the fundamentals of the two methodological approaches and then initially examines the results of these two methods for the 2010 decennial census in terms of consistency and inconsistency for age groups. The authors find that the two methods produce relatively consistent results for all age groups, except for young children. Consequently, the paper focuses on the results for children. Results of the 1990, 2000, and 2010 decennial censuses are shown for the overall population in this age group and by demographic detail (age, race, and Hispanic origin). Among children, the DA and DSE results are most inconsistent for the population aged 0–4 and most consistent for ages 10–17. Results also show that DA and DSE are more consistent for Black than non-Black populations. The authors discuss possible explanations for the differences in the two methods for young children and conclude that the DSE approach may underestimate the net undercount of young children due to correlation bias.     

On An Intriguing Distributional Identity

For a continuous random variable X with support equal to (a, b), with c.d.f. F, and g: Ω₁ → Ω₂ a continuous, strictly increasing function, such that Ω₁∩Ω₂?(a, b), but otherwise arbitrary, we establish that the random variables F(X) ? F(g(X)) and F(g^{? 1}(X)) ? F(X) have the same distribution. Further developments, accompanied by illustrations and observations, address as well the equidistribution identity U ? ψ(U) = ^dψ^{? 1}(U) ? U for U ～ U(0, 1), where ψ is a continuous, strictly increasing and onto function, but otherwise arbitrary. Finally, we expand on applications with connections to variance reduction techniques, the discrepancy between distributions, and a risk identity in predictive density estimation.     

An update on ‘a comparative study of tests for homogeneity of variance’

Tests for equality of variances using independent samples are widely used in data analysis. Conover et al. [A comparative study of tests for homogeneity of variance, with applications to the outer continental shelf bidding data. Technometrics. 1981;23:351–361], won the Youden Prize by comparing 56 variations of popular tests for variance on the basis of robustness and power in 60 different scenarios. None of the tests they compared were robust and powerful for the skewed distributions they considered. This study looks at 12 variations they did not consider, and shows that 10 are robust for the skewed distributions they considered plus the lognormal distribution, which they did not study. Three of these 12 have clearly superior power for skewed distributions, and are competitive in terms of robustness and power for all of the distributions considered. They are recommended for general use based on robustness, power, and ease of application.